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APPLICATION FOR. SANITATION PERMIT' Permit 0_9 (Complete in Duplicate) �'7 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ',p application is made in compliance with County Ordinance No. 549. .1 _/0 I S -------------------- JOB ADDRESS AND LOCATION........------------------------------ -—-------------- ------------------------- Owner's Name---- ---------- ----------- ------------ --------------------------------------- Phone-------------------------------•---- Address hone------------------------------------ -------------1-116 ------ ------------------------- ------ ---------------------------------------------------------------- Address---- Contractor's Name--------- .---•-----._� aw-------�!------------ ------;------------------- - Phone_----------------- ------------ J _t_ 7 Installation will serve: Residence 3-4artmerif House"/I C omme_rcial^Ej',�Trailer Cour-t' El Motel E] Other [I N'umber of living units: __/_'_'Nu1rnber of bedrooms _ " Number of baths _1_ Lot size ---------- - Water Supply: Public syst6m-W_Communify system El Private-Fl - Depth to Water Table _60ft. Character of soil to a depWof 3 feet: Sand E] Gravel [j S6-nd'y Loam El Clay Loam Ej Clay E] Adobe jZ._ Hardpan ❑ Previous Application Made:.!:Yes E] No F- New Construction: Yes E] No 3.FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank'or'cesspool permitted if.,public'seweir is avaiii'a'616 within 200'feiet.) Septic Tank: Distance from nearest w6ll�.wjq�N�6istan"cororrl;oundation---- Material--f_G - --------- J__v------------ Distance'from -A.,�'�Erfg�ce-from foundation___!' Distance to nearest lot line--_- ------- No. of �ompar -_Sin. _4�------------------Liquid depth f. Disposal Field: =1 we A Numberril"of lines------------ -----______-Length of each line--- Width of trench..__- ___ ------------ Type of filter maferiaJ__,/5 5-12!Depfh of filter length-----�w C2_92______________ __-_;V Seepage Pit: Distance to.nearesf We11_'__;!��_Distancel'fLQM fou'n'ciation---.Z-6---.-.rDi,tance to nearest lot line___/,a___ __Linin Diameter------ ------ --- Number'of p;ts.----- ------------L Depth--Cesspool: Distance from nearest'wel --------L-Distance from"founclafion---------------------Lining material_____.___________._.______.__________ p Liquid Capacify.---------------------------ga 1.s. F1 Size: Diameter--------------------------------------De 'th-----------1----------------------------------------- Privy- Distance irom nearest,well------------------------------------- ------ ----�Distance from nearest building--.------------------------------------.- F1 :Distance - - --------------- ------ nt - -- - Remodeling and/or reipairing (describe):--------- -------------------------------------------------------------- ---------------- ---•----.....'....-'----------------------------- -----------••--------------- -------------------------------------------------------------------------------------` ------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------ ---------------------------------------------------- ------------------------------------------------------------- -- j �I I I -V- ---- - ----- ------------7------------------------------•---------------------------------------------I---------------------------------------------------------------------- -------------- --- ----- I hereby-certify-thatI have • prepared this application and that the work will be done in accordan-ce-i0th San Joaquin County ordinances, %f4"ws, and rules and regulations of the San Joaquin Local Health District. --- ------------------------(Owner and/or Contractor] ---- ------ -- -------- - ------ --- ------------ --- -------------------------- Y. (Signed)------- --- ------------------------------------ --- ---- -- --------------------------------------(Title)-------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY H APPLICATION ACCEPTED BY----- ------------- ---- DATE------. -------------------------------------------- REVIEWEDBY----------------------::-------------------------------- ----------------- DATE------------- ---------------------------------------- BUILDINGPERMIT ISSUED---------------------- :- ------------ ------- -----------------=-'------------------------- DATE--------- -- --------------- -------------- �--------------------------I----------- -------------------------------------- ----------------------------- Alterations and/or recommendations:-------------------- -------- I-A IN5----------------------- ----------------- - - ------------------ --------------------------I------- -------- I ��_ --------- -------- --- - ------------- -------- ---- ------------------------------ _17 �� ...... .-- Q,-- ---------------------------- ----------------1�------------------------------------------------------------------------------ -------------------- ---------------------------- -- ------------------------------------- ------------------------------ ------ ---------------------------------- ------------------------------------------------------------------------------------ -- ----------------------------------------------------- FINAL INSPECTION BYc. - JT�L7 :---------- Date----- �--1-_��--,--` -,-77------------------------------------- �SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 FT CO.